This week in Medicare updates—3/16/2022
Announcement of the Approval of COLA as an Accreditation Organization for the Specialty of Pathology to Include Histopathology, Cytology, and Oral Pathology Under CLIA
On March 7, CMS published a Notice in the Federal Register to announce that it has approved an application from COLA to serve as an accreditation organization for clinical laboratories under the CLIA program for the specialty of pathology to include histopathology, cytology, and oral pathology.
Dates: This notice is effective from March 7, 2022, to March 7, 2024.
FDA Revises EUA for Tixagevimab Co-Packaged with Cilgavimab for Pre-Exposure Prophylaxis of COVID-19
On March 7, CMS updated its COVID-19 Monoclonal Antibodies webpage to announce that the FDA revised an EUA, effective February 24, 2022, for tixagevimab co-packaged with cilgavimab to change the initial dose for the authorized use as pre-exposure prophylaxis of COVID-19 in certain adults and pediatric patients. Providers should report this drug with product code Q0221 and administration code M0220 or M0221 depending on whether the drug is administered in the outpatient setting or in the home.
April 2022 Update to the FY 2022 IPPS
On March 7, CMS published Medicare Claims Processing Transmittal 11269 regarding the April update to the IPPS. Changes include the addition of two new drugs eligible for New COVID-19 Treatment Add-on Payments (NCTAP). This transmittal is no longer sensitive and may now be posted to the internet.
CMS published MLN Matters 12631 on the same date to accompany the transmittal.
Effective date: April 1, 2022
Implementation date: April 4, 2022
User Change Request: FISS - Modify Reason Code 38205 to Include All Patient Status Codes
On March 8, CMS published One-Time Notification Transmittal 11289, which rescinds and replaces Transmittal 11230, dated January 27, 2022, to add business requirement 12493.2. The original transmittal was published regarding a modification to the FISS to include all discharge status codes for reason code 38205.
Effective date: July 1, 2022
Implementation date: July 5, 2022
Correction to Processing When Osteoporosis Drugs are Billed for Other Indications
On March 9, CMS published One-Time Notification Transmittal 11290, which rescinds and replaces Transmittal 11190, dated January 20, 2022, to revise the background section and business requirement 12551.1 to limit the Types of Bill that are applied by edit 32453 rather than disabling the edit. The original transmittal was published regarding the removal of an edit that only allowed osteoporosis drug HCPCS codes to be billed by home health agencies.
Effective date: July 1, 2022 - Claims received on or after this date
Implementation date: July 5, 2022
Nursing Home Visitation FAQs
On March 10, CMS updated its Nursing Home Visitation FAQ document to differentiate some of the guidance based on vaccination status and provide guidance on visitors who have not had a positive viral test.
April Quarterly Update for 2022 Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Fee Schedule
On March 10, CMS published Medicare Claims Processing Transmittal 11292 regarding the quarterly update to the DMEPOS fee schedule. Changes affect continuous glucose monitors and include nine new codes added to the CWF effective April 1, 2022.
Effective date: April 1, 2022
Implementation date: April 4, 2022
HOP Panel OPPS Cost Statistics Two Times Run Document
On March 10, CMS published the 2022 HOP Panel OPPS Cost Statistics Two Times Run Document, which includes data that would be the standard rate-setting methodology for CY 2023 and is based on CY 2021 claims data and cost report data through CY 2020. However, this data does not necessarily reflect the methodology that will be utilized for rate-setting in the CY 2023 OPPS proposed rule. Standard rate-setting methodology for setting CY 2022 OPPS rates was adjusted due to the COVID-19 PHE.
Revisions to State Operations Manual (SOM), Chapter 2, Section 2779A1 - CCN for Medicare Providers
On March 11, CMS published State Operations Provider Certification Transmittal 205 regarding the addition of new provider state codes for California, Florida, Kentucky, Louisiana, Michigan, Mississippi, Ohio, Pennsylvania, Tennessee, Texas, and West Virginia.
Effective date: March 11, 2022
Implementation date: March 11, 2022